How To Stay On Top Of Payer Contracting And Drug Pricing? - PowerPoint PPT Presentation

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How To Stay On Top Of Payer Contracting And Drug Pricing?


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Title: How To Stay On Top Of Payer Contracting And Drug Pricing?

How To Stay On Top Of Payer Contracting And Drug
The contracts between insurance payers and
pharmaceutical manufacturers are here to stay in
the medical world. In the last few years, these
value-based contracts have been growing. Not only
that, these are bringing in higher payment rates
in the process of improving the outcome for the
patients. They are also supplanting the
traditional contracts in which rebates on the
payments were based on volume and the formulary.
What Is Payer Contracting Drug Pricing?
Theoretically, the 'at-risk' or value-based
agreements are developed for positive
development. The pharmaceutical companies in such
a scenario uphold the performance of the drugs
with these contracts. The process allows the
medical facilities to offer the best service and
results to the patients. However, the reality
has been a bit different. These contracts have
been based on un-advanced volumetric math, making
them a value-based idea but not fully functional.
It is because manufacturers are still working on
achieving a simple volumetric percentage. Read
How To Stay On Top Of Payer Contracting And Drug
How To Stay On Top Of Payer Contracting And Drug
How To Stay At Top? When it comes to speciality
healthcare - staying at the top of the payer
contracting and drug pricing is essential, even
when the value-based agreements offer a limited
scope. In addition, since most speciality
healthcare has used cutting-edge pharmaceutical
and other therapies at the high end of the cost
spectrum, maintaining revenue cycle management
(RCM) is essential. In such a scenario, the
provider and the payer want to ensure that the
patient has access to the treatment without
getting embroiled in the challenges that plague
the value-based agreements. As part of the
innovation and incorporation of the latest
technology, the healthcare system has been
changing at a rapid pace. More than ever, it has
become essential to monitor spending. Hence the
payers change the reimbursement rates for the
drugs frequently. For instance, the Centres for
Medicare and Medicaid Services (CMS) update their
drug reimbursement rate every quarter for
Medicare. Unfortunately, it results in many
payers of the nation following the same schedule,
thus leaving the providers of speciality
healthcare to scramble for constant adjustments.
How To Stay On Top Of Payer Contracting And Drug
It needs to be taken into account that even a
tiny adjustment in the rate of a high-cost drug
can cause a predicament to the financial health
of a practice. Therefore, the providers must
maintain comprehensive visibility into the
contract of the payers, their payment rates, and
the population of the patients all the time. One
of the critical steps in staying on top of the
payer contracting is to have an RCM solution with
features that are highly capable of contract
management. It should be able to differentiate a
flexible reporting system and take the necessary
steps to manage the contract of the payers while
updating the drug pricing. Given the expectation
in the healthcare system today with high service
volume, it is vital to leverage the best RCM
system to streamline the work process and improve
productivity by reducing the burden on the
administrative staff. It should also be able to
offer flexible adjustments to different financial
projections, support compliance reporting, and be
a sustainable solution in the frequently changing
medical environment.
How To Stay On Top Of Payer Contracting And
Drug Pricing?
How To Ensure You Are Doing It Right? These
are the solution to stay on top of the
much-complicated payer contracting and drug
pricing issues. But we know following these could
be pretty challenging. In such a case, contact
the 24/7 Medical Billing Services with the best
RCM software and a dedicated, experienced team in
medical billing and coding to ensure that your
revenue management is on the top. Then, based on
the speciality care and the facility's
requirement, we will develop the RCM that can
offer the best results for your practice while
ensuring you can scale better with improved ROI.
About Us
We are a medical billing company that offers
24/7 Medical Billing Services and support
physicians, hospitals, medical institutions and
group practices with our end to end medical
billing solutions. We help you earn more revenue
with our quick and affordable services. Our
customized Revenue Cycle Management (RCM)
solutions allow physicians to attract additional
revenue and reduce administrative burden or
Contact Us
Media Contact 24/7 Medical Billing
Services Georgia 3001 Greenfield Drive, Marietta
GA Ohio 28405 Osborn Road, Cleveland, OH
4414030068 Texas 2028 E Ben White Blvd,
240-1030 Austin TX, 78741 Delaware 16192
Coastal Highway, Lewes, Delaware 19958, United
States Phone no / Fax 1 888-502-0537
Email us info_at_247medicalbillin
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